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General NPI Number Information
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NPI Number | 1376040071
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Entity Type | Individual
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Provider Name | JUDY NELL WILSON MA, LPC
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Gender | Female
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Dates
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Enumeration Date | 04/09/2018
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Last Update Date | 04/09/2018
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Provider Practice Location Address
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Address Line | 12959 JUPITER RD STE 254
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City | DALLAS
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State | TX
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Zip | 75238-5250
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Country | US
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Telephone | 214-221-0132
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Fax | 214-221-0242
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Provider Business Mailing Address
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Address Line | 4900 WINDHAVEN PKWY APT 15102
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City | LEWISVILLE
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State | TX
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Zip | 75056-6110
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Country | US
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Telephone | 972-754-0313
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 73893
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License Number State | TX
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